Роль нового биомаркера ST2 в оценке ремоделирования миокарда у больных хронической сердечной недостаточностью ишемического генеза с сохраненной фракцией выброса левого желудочка

Aim. 1) To study the role of soluble ST2 (sST2) in evaluation of left ventricular (LV) myocardial remodeling and 2) to evaluate the predictive value of sST2 for development of adverse cardiovascular events (CVE) during 12 months following myocardial revascularization in patients with ischemic heart disease (IHD) and chronic heart failure (CHF) with preserved LV ejection fraction (EF). Materials and methods. The study included 55 patients (42 men) with IHD and NYHA FC I-III CHF with LV EF 63 [59; 65] % aged 65 [58; 69] who were scheduled for myocardial revascularization. Echocardiographic evaluation of myocardial stress and myocardial remodeling indexes was performed for all patients. Content of sST2 was measured using enzyme immunoassay. Results. Group 1 included patients with sST2 overexpression (≥35 ng/ml) (n=26; sST2-43.75 ng/ml) and group 2 - patients with the sST2 expression <35 ng/ml (n=29; sST2-25.8 ng/ml). LV EF was lower by 5.8% (р=0.017) in group 1 than in group 2. Cardiovascular resistance was 6.7% higher (р=0.022) in group 1 than in group 2. Indexes of myocardial stress were higher by 8.2% (р=0.026) during systole and by 7.8% (р=0.027) during diastole in group 1 compared with group 2. During 12 months following myocardial revascularization, the incidence of adverse CVEs was significantly higher in group 1 (67.59% of cases, р=0.006) than in group 2 (17.24% of cases). Levels of sST2 correlated with EchoCG indexes of LV structure and function (р<0.05): sST2 inversely correlated with LV EF (r= -0.301) and end systolic elasticity (r= -0.346), and positively correlated with end systolic volume (r=0.453), end diastolic volume (r=0.396), end systolic dimension (r=0.373), end diastolic dimension (r=0.288), cardiovascular resistance (r=0.286), and LV myocardial mass (r=0.346). Conclusion. In IHD patients with CHF and preserved LV EF, increased levels of sST2 were correlated with markers of LV structure and function. The study showed an interrelationship between myocardial stress and processes of myocardial ischemic remodeling and sST2 levels in patients with IHD and CHF.